A physician's perspective on recent medical items from the news and media

Friday, March 18, 2011

Good Bye Primatene Mist

As reported today by the Washington Post, Primatene Mist’s days are numbered. The FDA announced today that "the only over-the-counter asthma inhaler sold in the United States will no longer be available next year as part of an international agreement to stop the use of substances that damage the environment."

However, the loss of Primatene Mist is a good thing in my opinion. Primatene Mist is epinephrine. It is a bronchodilator, which is why it relieves the symptoms of asthma. However, it is quite dangerous, especially without a prescription. First, it is not just a beta 2 agonist like albuterol which works almost exclusively on beta receptors in the lungs. It also aftects beta 1 receptors in the heart and alpha receptors in the blood vessels. The primary use of epinephrine is medicine today is to give it to patients who are a risk of immediate death in order to restart their hearts. In addition, having any bronchodilator, even albuterol, over the counter, is a bad thing. We know that increased albuterol use is associated with increased ER visits, hospitalizations and even death. But at least we can monitor albuterol use, because it must be prescribed by a physician. We have no way of knowing if a patient is taking too much Primatene mist until they are dead.

Under a physician's supervision, with a proper asthma plan and additional chronic maintenance medications for asthma, such as inhaled corticosteroids, bronchodilators can be used safely and effectively. However, over-use of these medications especially in the absence of inhaled corticosteroids is dangerous. This is why I never write an albuterol prescription with any refills. If your asthma is well controlled, one albuterol inhaler should last you a year and you shouldn't need refills. If you are refilling the albuterol more than one time in a year, by the NIH's criteria, your asthma is not under control and you may need to change to a stronger daily medication (for example, switch from Singulair to an inhaled corticosteroid or ICS, or switch from an ICS to an ICS/LABA combination).

For those patients without prescription insurance who relied on the relatively low cost of OTC Primatene mist, be advised the GSK makes a sample size of Ventolin HFA (60 inhalations) that is only $9 out of pocket (regardless of insurance) at most major retail pharmacies. This will of course require a doctor's prescrition, but I believe that is a good thing for the reasons stated above.

124 comments:

Anonymous
said...

Writing this from a small mountain community in the West, a hour away from any kind of medical care. In the adjacent large wilderness, it is not uncommon for backpackers and horsemen to be two days away from any medical care and to have no communication capability. Some of us carry Primatine Mist inhalers in our first aid kits, even in the absence of specific known indications in anyone who is along:

http://www.wemsi.org/epinephrine.html

Would you see an OTC epinephrine inhaler as being potentially a lot better than having nothing under such circumstances, even if not optimal? Would the ability to deliver multiple doses over time in a very remote setting make it more flexible than, or perhaps a useful adjunct to an epipen?

certainly having an emergency kit in remote areas is a great idea. also, something is surely better than nothing. I am sure there is a way to get an albuterol prescription and an epi pen from a prescribing physician to ensure you kit has the most appropriate medications.

Your argument that Primatine Mist should not be OTC because it is too dangerous does not add up. I suppose you would like to take Tynenol and Asprin off the shelves as well, as these can be very dangerous if used improperly. That is, however, why they put directions on the box.

The truth is albuterols do not work for some people, while Primatine does. The major pharmaceuticals are using the CFCs as an excuse to push a small time pharm company, Armstong, out of the market. Then the consumer will be forced to come to your office where they can see your collection of Singulair branded pens, note pads, calendars, posters and wall clocks while you write them out a prescription for what else, Singular. A drug that will cost them more, give them more side effects and may not be as effective. I challenge you to throw away all of you Singulair branded products tomorrow, give back your free samples and start medicating based off of medical studies not funded by the pharmaceutical companies.

"I suppose you would like to take Tynenol and Asprin off the shelves as well" Actually, this idea has merit. Tylenol and aspirin would never be approved today for OTC use and may not even be approved by the FDA using current efficacy and safety standards. In fact, the FDA is looking into taking Tylenol out of some prescription and OTC meds where it is in combination with other drugs. Though I think it is safe to leave Tylenol and aspirin on the market for now, I believe the risks of OTC primatene are far great, and because albuterol is much safer, I am happy to see it go.

"The truth is albuterols do not work for some people, while Primatine does." Actually, I am not aware of any study the shows this. Every patient responds differently, and because Primatene is more potent, patients are likely to respond a bit better. I is possible that some patients respond only to Primatene and not albuterol, but the number of patients in that category would be very, very small.

"your collection of Singulair branded pens, note pads, calendars, posters and wall clocks while you write them out a prescription for what else, Singular." Pharma stopped giving out all of these things a few years ago.

"I challenge you to throw away all of you Singulair branded products tomorrow." If you search my blog, you will see that I am not a big believer in Singulair, and rarely if ever prescribe this.

"start medicating based off of medical studies not funded by the pharmaceutical companies." Unfortunately, most therapeutic studies are funded by the industry. The government or other non-biased parties rarely do any therapeutic research. The asthma guidelines come from the NIH (goverment) but base their findings of studies that are mostly funded by the industry. The NIH guidelines state that beta 2 agonists should only be used intermittently, and use of these meds more than twice a week indicates poorly controlled asthma that increases risks for hospitalizations and death. They recommend that any patient taking rescue inhalers more than twice a week take an inhaled cortiscosteroid. I have worried that with OTC Primatene that patients would use this more than twice a week without the use of an inhaled steroid (which requires a prescription) and increase the risk of hospitalization and death. Thus, I remain glad to see Primatene Mist go.

Ventolin HFA 60 (sample version) is available at most retail pharmacies at $9 without insurance. You will of course need a prescription to get this. Hopefully their is a retail or community clinic in your area that will see you at low cost. If not, there is always the emergency room.

most communities have free clinics where a physician can give a patient a prescription at little to no cost. In addition, ER's have to see patients regardless of their ability to pay. Primatene mist is a dangerous drug and should have never been available over the counter. Furthermore, any asthmatic should be followed by a clinician and not manage their own disease alone. This is also true of other diseases such as hypertension, cardiac disease and diabetes. I recongize it would be more convenient for patients to just go to CVS, but that is not good medicine. For patients without health insurance, there is obviously more to this than just inconvenience. However, it is still bad medicine for asthmatics to manage their disease without physician supervision.

I have a form of asthma called asphyxic asthma where i can go from normal to dead in seconds. Primatine Mist is the ONLY thing that saves me when I have one of these attacks..Without my primatine mist inhaler i would be long time dead before rescue personell could get to me . What do you propose I do besides hitting myself with an epi-pen several times daily (and yes I am prescribed epi in pen & bottle form!) or permanetly residing in a hospital for the rest of my life ?

Thank you for your medical insights. Is it possible you could give reference to actual clinical trials indicating side effects of Primatene Mist ? As I understand, epinephrine is close to actual substance produced in the body.

Clinical trials of primatene mist are so old that I am not sure they would be relevant. (Couldn't easily find a reference). The fact that epinephrine is a natural substance does not mean it is safe and without side effects. When the body makes epinephrine that's fine. What we are talking about is much higher (toxic) does of epinephrine, which can cause lots of side effects. The body makes estrogen and thyroid hormone as well, which are used as medicines. However, these medications also have side effects.

I have read Tachycardia is a common side effect of adrenaline administered subcutaneously or intravenously. But it seems inhaled adrenaline usually reduces heart rate or only slightly increases heart rate. One publication said that the potent vasoconstrictive effects of adrenaline onthe respiratory mucosa limit its systemic absorption andconsequently its ß1-adrenergic (tachycardia producing)effects. It was reported that adrenaline reduce the inflammatory airway obstruction unlike Albuterol which has only bronchodilatory effect and significantly increases heart rate. Is there any comparison on the relative safety of Albuterol vs Primatene Mist for mild intermittent asthma without the use of ICS ? Please advise.

I think your selfish to those of us who dont have insurance an cant afford the high dollar doctor bills.. I dont think this is a good thing for alot of people .. There will still be ways to get it so you havent stopped it .. you suck hope you cant breath ...

I am a 62 year old male that has used primatene mist sence it came onto the market. I had severe asthma in my younger years where I didn't have medication available, aside from some asthmadore, if Dr mintz knows what that is. I never had axcess to a medical doctor, just couldn't afford it. When I became a teenager a device called a nebulizer ( glass device where forced air changed the liquid medication to a vapor)came out. It worked very well and cost almost nothing. A small 2oz. bottle of medication used in this device would last for an onbelieveable amount of time. It's a shame they pulled it from the market. I've never had any side affects from primatene mist whatsoever. I've never taken more then the recomended dose at any one time but as many times a day as needed, and that at times went into the double digits. I really doubt it's anywhere near as dangerous as you suggest. My son and daughter both have asthma. They now use a doctor prescribed medication until there prescription runs out ( refills you won't won't write) and then they are back to primatene mist. It actually probably saved my spouse life one night when she had an allergic reaction to a blood pressure medication she had been taking for years. Her face swelled and she couldn't breath. A panicked me took my primatene, (knowing it had epinephrine in it) and gave her two puffs. Within minutes her breathing became easier. Do you thing I would even slightly risk their lives if I thought primatene was risky? I noticed you saying you don't prescribe refills. I wouldn't either if I knew the ($) I was going to make from appointments and prescriptions from $80.00 a bottle drugs you prescribe. Are you sure you didn't migrate from wallstreet? Lets see ($) x how many people use primatene mist is this world. Oh yes, my nephew is a doctor.

I'm a 56-year-old asthma sufferer who has pretty much used Primatene daily since the 1970s. I have NEVER been to the emergency room for asthma or (WTF) "epinephrine poisoning". I've tried the albuterols, but they're not effective at all.

I'm assuming that Dr. Mintz is not an asthma sufferer himself. I don't know what kind of patient would be at risk from inhaled epinephrine, but if there are studies or even anecdotes of people dying from Primatene abuse, I'd like to see the evidence. I don't believe it exists.

Singulair is worthless to me. I found Advair to be worthwhile in controlling my asthma, but it's incredibly expensive. Given the choice of spending $80 every month to control my asthma, or $20 every two months to manage it, I'll choose to manage it with Primatene.

Hopefully someone will bring out an epinephrine inhaler using HFA that will sell over-the-counter. I am certain that there will be many more emergency room visits and likely even deaths because this medication is no longer available than were ever caused by its purported abuse.

Your attitude is that of a clinician, not a sufferer of asthma. I wonder what all the physicians will say when the first death is reported because some person no longer had access to Primatene Mist. Shame. This will take a lawsuit to overturn. Ephedra was banned by the FDA and guess what it took a federal lawsuit to put it back on the market. Unfortunately, many will die in the meantime. I hate physicians. I had to go to the ER this summer and did not have insurance. It cost me over $2,000. How cost effective is that in the long run? Is it reasonable to send people who are having an acute asthma attack to the ER? When all they need is a few puffs on a cheap, effective inhaler. Whether the person has insurance or not, that is a waste of money.

This was nothing but a cash grab by FDA. They make up a bunch of phony claims about the competition's product, pay a bunch of crock doctors like this clown to back them up, and effectively get it removed from the market. it's all just big business. where's the tangible evidence of this particular product being harmful to the users or to the environment? The FDA has approved countless medications that leave patient in worse condition than they started. And I'm quite sure this "doctor" has prescribed just about all of them to his patients at one point or another. Why would they do this? because the pharmaceutical companies keep their pockets nice and fat in return for pushing their poisons on us, the unexpecting victim... I mean patients. Why else would they remove a product that has been effective for so many people who suffer from asthma and other breathing complications? If it was so dangerous it would've been pulled from the selves long ago. The truth of the matter is, FDA approval has absolutely nothing to do with the safety or the effectiveness of a product. It's all about $$$

I have been using primatene mist since I was 12. I am 40 now. Since that time I have tried ever medicine used because I knew the time would come for it to be off the market. Out off all the medicine, Ventolin, abeuterol, etc., nothing works like primatene mist. I have seen the docter after docter, and prescribe medicine after medicine, and still nothing works like primatene mist. By taking this off the shelves could result in a lot of death. May God be with you.

Obviously we ALL see this is a bunch of BS. We need to come together and do something to get this over turned. Primatene Mist had been my 3rd lung for omost of my life. NEVER EVER hospitalized for using it. It works better than breathing treatments for me. I wish this Dr. would have never tried to answer these questions because its like a big slap in the face. F you broke MFers is basically what the Dr.s are saying. Well you know what punks...F u 2 fraudulent faggots. Primatene Mist will make its way on the black market. The government cant stop the flow of drugs into our country but finds a way to attack its citizens with breathing problems. Cowards

I do think this drug is dangerous and should be pulled off the market. I think the use of this medication made my health worse and I seriously believe had I not of gotten off of it when I did that I would not be here to type this comment in now. I am 43 years old. I started using this medication in 2000 and continued until 2005 where I had some major problems with my health. At first it worked great but as time went on I found myself without realising it that it was taking more and more of it to control my symptoms. I didn't see any vivd warning labels and being it was over the counter I had a false sense of security in thinking it was totally safe.It started off with a higher heart rate off 110-120 bpm and increase in blood pressure that had me started on blood pressure medication. Later I went on to experience horrible stomach pain, nausea and vomiting to the point where I could not go to work. This resulted in my having a cholecystectomy done. The illness continued.I was found to have a large liver with no etiology,wound up in the hospital for a week with more GI comlications have to have a blood transfusion. One day I went to use the inhaler when my lungs felt like I had sprayed pepper spray into them.Finally I saw an old school MD that told me to get off that medication that it was killing me. I did take his advice. My lungs paid the price I now have Moderate COPD. When it comes to a drug that plays such an important roll as your Breathing and just your overall health this should be monitored by a MD.I blame myself as much as I do the drug. I didn't see a doctor as I had no health insurance so my asthma was poorly treated, but nothing in or on this medication made me know what my risks of taking it were.

Primatene availability is already near zero today on December 8 even though the Primatene box says it will be unavailable in January 2012. People who do not have the luxury of driving from store to store seeking a new one when their inhaler runs out this month are going to die. I hope the bus gets them to the ER before that happens. I also hope not too many people are ripped off by internet fraudsters claiming to sell Primatene online. Ah well, let's face facts: It's just poor people / minorities who will die in the coming weeks, right? Wrong. Rich folk, fly but forget your prescription inhaler. Good luck with that!

So now the FDA is concerned about the environment? This is so very transparent. Cigarettes are sold over the counter, are far more dangerous than a Primatine inhalor, especially to Asthma sufferers who are often forced to inhale second hand smoke.

How much did Big Pharma pay you write this article Doctor Mintz?

I've been in Primatine for years. It's the only thing that works for me. Even Singular did nothing by comparison. In seconds I can go from a bad asthma attack to breathing freely because of Primatine. I have never known anyone who has ever suffered medically due to using Primatine (unlike most of the drugs your industry irresponsibly pushes).

Doctors are about as trustworthy as mechanics and lawyers these days and what's worse, they seem to have less and less time to spend with each patient and know so very little about the drugs they push.

I have used Primatene mist since I was a child and have never been hospitalized from using it. However I have been from NOT having it. For the last 2 years, knowing they would be taking it off the market I have been trying ALL of the RX inhalers, and NOTHING has worked for me. As of today, I have written my will and instructed my family to document what happens to me as I face my upcoming death. After I am gone I want them to sue the pants off the FDA!!!! I know I am not the only one who will suffer and DIE from this decision.

Primitine mist has never hurt me but it has saved me countless times. the script inhalers all choke the life out of me, they do my dad too. Even with the bags, spacers and whatnot they still gag the hell out of me. Primitine was there to save me countless times. If there is a movement to bring it back please contact me at zoomin41@ymail.com I'll be on that train for sure. You Doctors have no damn clue what has been done with this ignorant move by the FDA and it all comes down to money. Primitine was cutting into the big pharm pockets a little too deep so they got rid of it. There will be deaths associated with this decision. I hope you pompous bastards can live with that. I am sure you can because you have no damn souls left. I have used it my entire life, I am 42 and I have never had a reaction to it what so ever other than, get this , I could get air into and out of my lungs. Take your crap drugs you push, with many more side effects and shove them A-hole.

Wow. What an arrogant and pompous article. " I won't write a refill" and "just get a a prescription" or "go the emergency room" Are you really that out of touch with the state of affairs in the US or do you just not care? An er visit cost 1000's and you best believe the hospitals come at you with both barrels if you don't pay. Even if you have insurance the copay can be 25 or 50 bucks. Then another at least 50 or so for the prescription to be filled. When a family only has maybe a couple of hundred bucks to last the two weeks until payday after paying mortgage, food, utilities going to the doctor can be out of reach even for folks with insurance. People without it forget about it. Maybe primatene mist wasn't optimal. I don't know. I do know it was a valuable to people who have very limited choices. I can tell by reading this blog post you do not Cate or understand or Mayne even care to understand. I do know that people have held the medical profession in high regard for years, and rightly so. I do think it is time we understand that doctors do not give a rip about us as patients. They care about our safety only as long as it doesn't raise their malpractice insurance past that they care about the money. Which is fine it is what it ia. Just don't come righting vs like this blog acting like you care about what is best for the patients because that is a falsehood.

Wow, Thanks to this crap I found the last store that had 2 left! I went there and was told I could get one and the Pharmacist refused to sell it to me even though they had 2 left! Now I will be out soon and will have to end up making a trip to the ER due to no insurance at the moment. It has never cause me any problems and I have high blood pressure! This is such BS! They care about the environment. Psh! What a huge scam! It's all about the money! This is rediculous! Let me tell you. I am thrilled just as much as the other people in this article! If they are so worried about the air then lets stop using cars, hair spray, people smoking... the list goes on!

Medicine may be an applied science, but it is still a science and as a scientist you must hold yourself to the same standards of accuracy as one would expect of any mathematician or physicist. In the case of medicine is it even more important than in any other field of science because your practice directly affects the quality and length of people's lives.

Anonymous-Reference #1 is an AMA consensus statement from 2000 stating "The AMA encourages the FDA to reexamine whether OTC epinephrine inhalers should be removed from the market."Reference #2 is a German Dermatology journal (probably not a good authority on Primatene Mist) from 2008 that is focused on anaphylaxis and not asthma. They state that for anaphylaxis "Intramuscular administration of epinephrine is superior to subcutaneous administration." I would agree. Patients with anaphylaxis should use an Epi-Pen, not Primatene. Reference #3 is a 2005 study in eight patients (don't know how this got published) showing equal efficacy of albuterol to epineprhine. (The issue with Primatene is not efficacy, but whether it is safe to use over the counter). None of these are large, randomized trials that look at the efficacy and safety of epinephrine. Moreover, the only relevant article to OTC use of inhaled epinephrine for asthma shows the AMA suggesting the FDA consider taking off the market. I thus stand by my original statement that Clinical trials of primatene mist are so old that I am not sure they would be relevant." Our health care system is horrible. Unlike most countries who have universal health care, about 50 million US citizens are uninsured and many are underinsured. In addition, co-pays for prescription medications for poor patients who have insurance make it difficult for many to get their medications. This is a situation that must be fixed. However, that does not mean that a potent and potentially dangerous medication should be used without a doctor's supervision and monitoring. For those lacking coverage, there are a variety of solutions. Up to 50% of people elligible for Medicaid simply have not signed up. Many areas of the country have free community clinics that offer free services. Again, this does not solve the problem. However, neither does allowing Primatene mist to remain over the counter.

It makes no sense that an affordable over-the-counter asthma inhalant was pulled from the market without a replacement. I understand the decision to pull Primatene Mist happened in 2008 to comply with international CFC rules. But I urge the Obama Administration to reverse this decision until a replacement inhalant is developed. I along with perhaps thousands of other asthmatics could die because of this decision to pull Primatene Mist from the market.

Here's the link for Walmart. I believe you can get ventolin for $9 at any major pharmacy.http://walmartstores.com/pressroom/news/8887.aspx

Regarding seeing asthma patients for free, as I stated before, the lack of access to healthcare for so many in our country is horrible. However, that does not mean that it's OK to provide poor or even dangerous healthcare because of this problem. I don't think patient should manage their diabetes on their own, I don't think patients should manage their high blood pressure on their own, and I don't think patients should manage their asthma on their own.

"Actually, I am not aware of any study the shows this. Every patient responds differently, and because Primatene is more potent, patients are likely to respond a bit better. I is possible that some patients respond only to Primatene and not albuterol, but the number of patients in that category would be very, very small." Your words Doctor well guess what I'm one of that very, very small group. I guess that means I'm worthless, and it doesn't matter whether I need oxygen.

If albuterol doesn't work for you, there are several other alternatives. I am not opposed to inhaled epinephrine in the rare cases that it is needed. What I am opposed to is Primatene being over the counter and used without consultation of a physician. If your asthma is so severe that you do not respond to albuterol, then you should be monitored by a physician regularly.

My husband has now run out of his Primatene Mist Inhaler. With no insurance and no way to find Primatene, which he's taken for 25 years, he is unable to make it to work today due to his lack of oxygen!!!!!! This is the most horrible move you doctors have pulled in a long time and I agree, its all about the money!!!!!!!I have tried everything to find just one refill...

1. Dr. Mintz means well but I'd like to see the study that shows Primatene Mist was as dangerous as he claims. Now I'm sure there are risks but, over the counter pain medications can be just as dangerous and we haven't banned them yet.

2. BEFORE we ban a product that has obviously helped many individuals we should make sure a comparable product at comparable cost is available to replace it. A sample vial of albuterol rationed out without refill is not an acceptable option.

3. The ban is simply illogical. Let's take this product off the market while we allow everything from hairspray to cigarettes to stay? Where's the study that shows asthmatics use of primatene is more harmful to the environment than the BILLIONS of automobiles in use?

SO in order to afford to take care of myself I must apply for financial aid? This is nuts...COMPLETELY NUTS!

Anonymous 1/23, you raise a few good issues. Let me clarify:1. Danger of Primatene vs. danger of albuterol. Both are dangerous. There is clear evidence that over use of albuterol, particularly if used without an inhaled corticosteroid, leads to increased ER visits, increased hospitalization and increased death rates. There is no data to show that Primatene is any worse (mainly since it is an older drug and over the counter). However, it's at least as dangerous as albuterol. Also, because of it's lack of selectivity for the beta 2 agonists (it affects the heart and lungs, whereas albuterol affects only the lungs), it definitely has more side effects. I don't think albuterol should be over the counter, and I don't think Primatene should be over the counter. I prefer albuterol over Primatene because it has fewer side effects and is better studied. Regardless, I think both medications should be used only under a physician's supervision. 2. The logic of the CFC ban. I am not arguing that the CFC ban was logical. The amount of CFC's in inhalers is probably so small that it has limited affect on the environment. Their is no question that the drug companies who make the HFA products benefited from this, though I have no knowledge of any shady dealings. 3. Cost of health care. I can't state enough that are health care system is horrible. Every American deserves affordable health care. No American should have to decide between feeding their family and taking needed medicines. This is true regardless of whether they have high cholesterol, diabetes, high blood pressure or asthma. That said, in the same way that I don't feel any of the above conditions should be managed by a patient on their own, I similarly feel that asthma should be managed with consultation with a doctor. I feel horribly for asthmatics that used Primatene because they can not afford anything else and can not see a physician. I hope that our country can fix this situation ASAP. However, this does not justify the availability of over the counter Primatene in my opinion.

The people who claim "most communities have a free clinic" or assume that those without insurance can just blow a magic flute and jump on state-funded healthcare programs are full of more holes than the ozone that is believed to be more important than human life. The fact is, Primatene - just like herbal remedies that we KNOW work for other problems - is being pulled because it is taking MONEY out of the pockets of physicians, hospitals, and insurance companies, and when those economic giants lose money, the government loses income taxes on their high pay. Primatene is being pulled because of the propellant, with claims that it is harming the ozone, not because it is anymore dangerous to human health than the chemicals doctors prescribe and cash in on every day. The fact is, human life is not nearly as important at the lower end of the income scale, and it is naive, selfish, and rude for doctors to spout off, "Just go to the ER" or "Anyone can get a prescription" or "Find a free clinic," because these options only sound good. In real life, for those of us who cannot afford doctor visits, prescriptions, or insurance but also cannot get assistance because we have the luxury of choosing between food or healthcare for our children, this advice is about as ridiculous as telling someone they can fix their car by taking it to a car wash. Primatene was pulled because it keeps low-income people alive without the high-income doctors and Big Pharm cashing in on it. My husband has severe asthma, and eno0ugh Primatene to last maybe a month if he's lucky. In this country, one can get in legal trouble for not intervening when they see someone else being harmed. Nice that the people who pulled Primatene get some kind of buy on that, since they can now stand idly by and watch millions of Americans suffer.

Dear fellow asthma sufferers -- I encourage you to write to your congressman, senators, and the FDA: , urging them to rush approval of a new version of CCF-free Primatene Mist which is currently being developed by Armstrong Pharmaceuticals. Better yet: put the old inhaler back on the market until such time as the new one is available. People's lives may depend on it! Like many of you, I have used Primatene Mist since it first came on the market with no ill effects. It is by far the most fast-acting and effective product I've ever used and I've pretty much tried them all. I lost my job in August and have no health insurance. If I want to breathe, I am having to pay out of pocket for Advair ($215) and Xopenex HFA ($52) -- products with far more dangerous side effects than epinephrine. Dr. Mintz, I thank you for providing this forum for people to express their opinions. Based on my experience of forty years of using Primatene Mist, I believe your prejudice against this product to be unfounded. The products you suggest are not very effective and the fact that you want to charge your patients for office visits every time they need a refill in addition to the high price they are already paying for the medications, says you are sadly out of touch with reality. You obviously have never known what it's like not to be able to breathe comfortably. It's too bad you can't substitute a little compassion for your arrogance and smugness related to this issue. Meg

@Meg-I was an asthma sufferer as a child so I do know what it is like not to breathe.I am very sorry you lost your job and insurance coverage. Advair and Xopenex are not far more dangerous, and in fact, are likely substantially safer. In addition, if you see a physician, he or she should be able to get these medications to you for free if you have no health insurance (see each company's web site for information or email me if you can't find it).

@autiejSince I have no knowledge of the role of those that might have benefitted from the removal of CFC's may have had in this legislation, I will not argue the point. However, even without the CFC ban, I do not think that Primatene should be over the counter. I believe that asthma, similar to other chronic diseases such has high blood pressure and diabetes, should be managed by a physician. Some diseases like heart burn and allergies are less serious, and over the counter medications taken as directed are likely OK. I do not believe asthma falls into this category. There are 4,000 deaths per year due to asthma; 200,000 hospitalizations and almost 2 million ER visits. Also, Assuming you still live in Tremont City, there is a free clinic about 45 minutes from your location: Compassionate Care of Shelby County124 N. OhioSidney, Ohio937-492-9400They see patients who are uninsured or have no insurance.Also, as above, if you husband needs medications, physicians there can get you most of the prescription medications for asthma for free from the drug companies that make them.

i too am or (was) a primatene mist user and am unable to use albuterol as it does not work for me , my asthma is very bad and now i will more than likely die because i now have no primatene mist inhaler by the way doc.... proventil , albuterol , ventolin are 52 dollars each with no insurance , not that it really matters because they never worked for me... thx for being part of the move to take my life Dr.

I am a respiratory therapist AND a moderate asthmatic. I have seen people die from primatene. Epi is whatw e give dead people to estart their hearts. I am sorry for those of you that cannot afford medical care or cannot get medicaid. Yet I notice everyone has access to a computer or cell.

Aside from that, it has long been known in the emdical community about the dangers of primatene mist and it should have been removed years ago. As your asthma episode increases, your carbon dioxide level goes up, eventually shutting off your respiratory drive. Epi in primatene form is often misued and hastens these effects.

Predniasone is relatively cheap and can be taken low dose daily if you cannot afford advair. One of the reasons advair gets a bad rap is because people use it as a rescue inhaler rather than the preventative it is meant to be.

I am shocked at people wailing on this dr as if it is his fault we have asthma. I am on singulair and flovent. Previously I was on theodur but after years of it raising my blood pressure I switched to the flovent. I have a ventolin inhaler which lasts me about a year as well as a nebulizer at home. My first breathing machine was concoted for me by my ex husband who used a tire inflator and gerry rigged the pressure down to a normal psi. I got hold of a nebulizer and got a RX from my dr.

Do not blame those of us lucky enough to have insurance as if it is our fault you will not go a clinic and get the $9 ventolin inhaler the dr is suggesting . Much safer. If ventolin does not work for you, you may not have true asthma. It may be COPD, it may be chronic bronchitis or another lung disease. If it is asthma and albuterol doesn't work it is because you need a better regiment o treat your disease.

I agree that this one single doctor should not be blamed for this problem, but I'd have to disagree with the fact that Primatene alone kills people. The fact is, prescribed medications are dangerous also. If they weren't, there'd be no need for warnings of side effects, and the people who publish the PDR would be out of business. The fact is, medications are chemicals, and any can be dangerous. The issue here is that we live in a world when cigarettes and alcohol, which we KNOW are directly responsible for causing disease rather than treating symptoms, can be more easily bought over the counter than medicine. The other issue is that those who are, as the good doctor put it "lucky enough" to have insurance, have a distorted and stereotypical mindset about those who can't afford it. Statements like "why do you have internet if you don't have insurance" are ridiculous and off topic. For instance, in my case, I have the internet because it is how I do my job. Contrary to popular belief among those who do not struggle, those of us who do are not always lazy or expect the government to pay our bills. What we do expect is for the government to make it possible for us to take care of ourselves, and a government that is pulling medication from the shelves when it is some people's only affordable remedy is wrong on every level. The government allows the sale of cigarettes and can ticket us for not wearing our seatbelts, but they can pull a medication simply because they say it has potentially dangerous side effects for the ozone, of all things. It makes no sense. And as far as that $9 prescription, I'd like to know where to get it. I would happily go to a clinic if I didn't have to fork out two weeks' worth of grocery money to walk in the door, and then another $60 for a one-month prescription so my husband can breathe. We both work, we don't have welfare, and while we aren't among the "lucky" ones who have insurance, we should be "lucky" enough to live in a country that cares about all of its citizens and not just the ones in the higher income tax brackets. It's simple: If remedies like Primatene exist, people do not have to pay to see doctors or line Pfizer's pockets. With Big Government, Big Medicine, and Big Pharmaceuticals working together, those of us who DARE to have the Internet while not earning six figures a year are not even granted the privilege of breathing affordably. And for the record, if I read a post like that from my physician, he wouldn't be my physician for long. I'm not sure how much more uncaring and condescending someone can sound, and there is something to be said when a doctor tasked with caring about people cannot even attempt to sound compassionate to those who need and struggle to afford medical help.

"And as far as that $9 prescription, I'd like to know where to get it. I would happily go to a clinic if I didn't have to fork out two weeks' worth of grocery money to walk in the door, and then another $60 for a one-month prescription so my husband can breathe."Autiej, please see my abover response from 1/30 where I specifically looked up a free clinic near your likely address. You should be able to go to this clinic for free and get prescriptions for asthma/COPD medications. Assuming you get a reasonable assessment, you may need controller medications like Advair. If you don't have prescription coverage, the clinic should be able to enroll you in a program that gives you the medicine for free. (The same is true for Ventolin). If you do have prescription coverage, their are coupons that lower the price to $25 for a month supply.If you or your husband just need a replacement for Primatene (which I doubt, since if he has severe asthma he should be on something linke Advair), Ventolin is available at CVS, Walmart, Target, RiteAid, and other major retail pharmacies for $9 (with a prescription). America is a great country, but we have some issues. Many of our citizens go without adequate health care coverage. We also allow harmful products like cigarettes to be sold. However, this is not the point. The point is that asthma is a serious disease. It should not be managed without a doctor's supervision. If you husband truly has severe asthma, he should not be on Primatene mist. He should be on a prescription controller medication so that he doesn't need a rescue medicine like Primatene. And, if he still needs a rescue medication, he should be on something that has fewer side effects, such as Ventolin or Proventil. There is very good data that patients with severe asthma not on controller medications are at risk of worsening lung function, hospitalization and even death. Please get your husband evaluated and properly treated at a medical clinic (such as the free one I directed you to ) ASAP.

As an asthma sufferer who used primatene and now has to pay the cost, my heart, health, and lungs, please seek professional medical help. I wish I had known sooner so I could have stopped sooner. Read that label so you can realize you do not know have the words on it. All this good doctor has said to us is seek a medical professional and stop diagnosing yourselves. Good advise. Primatene worked for my grandmother, for her lung cancer... She never had asthma. Maybe its working for you because its not asthma. See a doctor. Love your family enough to find out what can work or control it. No one wants to explain to their loved ones, their kids, husband or wife, that we just don't have as much time together as normal. That my heart or lungs just won't last that Much longer. They are worth that day to travel to the free clinic, they are worth me calling or researching that rx company to see what offers they have. And most of all, you are worth it. So stop complaining and take care of it before it takrs care of you. Thank you doc for bringing this subject up. I read the article and every post. Most people are just jerks who can't read the label enough to understand what it days so let me translate... Primatene will kill you!

You obviously don't have asthma and have no idea what it is like to suddenly not be able to breath. I want you to take a coffee mixing straw and try to breath through it, then try to make your way to the nearest medical facility, it it's open,... and wait for an exam and an RX while still breathing through the mixing straw. See if you make it. The same applies if you have your ONE prescribed inhaler (they never prescribe more than one) but accidentally lost it or left it at home. Removing asthma inhalers will CAUSE more deaths and visits to the ER then reduce them. If you do not know what it is like to live with asthma, your OPINION of the situation regardless of you unsubstantiated medical explanation is irrelevant.

I appreciate the information about the clinic, but that's just the point. I have been trying to find a clinic for a very long time - not just for my husband's asthma, but also for my daughter and myself to have some kind of go-to healthcare - since we don't have insurance and simply cannot afford office call costs as well as prescription costs, further complicated by the fact that few physicians will see anyone who is uninsured and needs to make financial arrangements and payment plans. The clinic you recommended is not in my county, and they only serve people in Shelby County. They closed the clinic down in my county several years ago. Case in point, I had a wisdom tooth that severely needed extraction, and since they closed our health clinic down and clinics in other counties are reluctant to see me (because I am not on government assistance and fall just above the cusp of help because I do work), I had to go to the emergency room when I had a severe infection from my tooth. For that, they charged me nearly $400, a bill I am still very much struggling to pay bit by bit. The ER doctor scolded me for not having it treated earlier and told me, flat-out, that the infection could kill me if I didn't go have the tooth extracted. As dangerous as it was, all the ER did was give me a prescription for an antibiotic and some vicodin and a warning that I needed to see a dental surgeon right away. I realize they are not staffed with dental personnel, but I couldn't afford a $400 surgical tooth extraction or I would have had it done before I went there. When I asked if they knew of any local places I could go that would work with people financially, their answer was "No. Our health clinic closed down years ago. You'll need to see a regular dental surgeon - as quickly as possible, hopefully before this antibiotic is gone." Had it not been for the kindness of one of my clients prepaying me for a year's worth of work for him, I could have died from an abscessed tooth because there are no clinics in my area and no doctors who are willing to work with anyone financially. It is not that I want FREE healthcare because I believe there are far too many people in this country who could work and will not and expect to be taken care of without putting any effort in. Rather, it is that I need it to be affordable to those of us who do work but are barely making ends meet. I live at the level where that 45-minute drive you mentioned to the clinic (who won't see my husband anyway) could be an issue because of the gas to get there, and there are a lot of people out here like my family who really do struggle each and every day just to put food on the table, even though we are working full-time and even sometimes more hours than that. For that reason, Primatene was a solution we could afford; albeit not the perfect solution, but at least a doable one. There are not enough clinics and doctors for those of us who need financial patience, and for that reason, helps that we can buy without having to pay office visit costs and occasionally heavy prescription costs are the lesser of the evils. Of course there are risks with Primatene, just as there are will all medications, but it's far riskier to allow asthmatics' very ability to breathe become dependent on their ability to pay office and prescription costs that they simply cannot pay. In any case, there is no sense beating a dead horse (I wonder if the horse had insurance?). Again, you win, Big Medicine, Big Pharmacy, and Big Government. Way to weed out those who have less income to pay taxes on...

@autiejAgain, I completely agree with you that our country should provide comprehensive care for all of our citizens. It is horrible that we don't. This; however, in my opinion, does not justify asthmatics self-managing their asthma. I think it is far too dangerous. There are alternatives for those without coverage. Are they enough? Absolutely not! But they exist and are far better than practicing medicine without a medical degree. The Rocking Horse Community center is located in Springfield, is much closer to you, and you shouldn't be limited by your residence. I strongly urge you and your family to get proper medical care there.If for some reason that doesn't work, I spoke with a wonderful colleague of mine in Bowling Green, OH who has agreed to see you for free. I realize that this is about a 2 hour drive, but I am willing to pay for the gas. If you are interested in this option, email me directly at drmintz@gmail.com

Wow,this dr.is at least letting this blog run, Iam from Canada and have been using Primatene since I was 10 Iam now 53, Ive used it on average twice a week, I get asthma from sports to cutting the lawn to dust and have tried Ventalin etc. works but not like Primatene,I hope theres a replacement soon.,Like one person stated, its like breathing through a coffee straw !!! We need a replacement please....

While I understand the medical professions stance on OTC drugs being dangerous I don't fully agree with OTC inhalers being gone forever. I do have to say that I use Albuterol, which is very effective.

The problem I have is getting a prescription refill in time. I use the VA and sometimes I won't be seen for months, sometimes I run out before I can get seen again due to the large ratio of patients to the understaffed VA clinic. A lot of times I have to rely on OTC inhalers to get by and since the visits & prescriptions aren't free, it can be hard on my family & I financially sometimes. For some people like myself, the OTC inhaler is more of a supplement to my doctor supervised treatment when I'm either in a financial bind or I can't get seen in time.

Being able to breathe is worth it; even if it's an OTC inhaler until I can visit my PCM at the VA, is a life saver in a pinch. On another note, thanks for working in the medical field we need more of you doctors really bad.

VA Patient, Thanks for your post as well as your service to our country. Though we don't seem to have sense enough to provide health care for all our citizens, we at least have sense enough to provide coverage for our Veterans. Having trained and done some after hours work at a VA, I know that being a VA patient is not always easy. However, you do have access to health care and therefore should never be but in a situation where you need to rely on OTC inhalers.If you have asthma, an albuterol inhaler should last you 6 -12 months. If you need it more frequently than your asthma is not under good control and you need stronger maintenance or every day medicines.If you have emphysema/COPD (which many of our Veteran's have since our military decided to give our servicemen free cigarettes), then you unfortunately may need a regular rescue medication. In that case your rescue inhaler should last at least a month and your doctor should give you adequate amount of refills. If your rescue inhaler does not last you a month, then your COPD is not under good control and you need more everyday medicine. Most COPD patients in our country take two every day inhalers in addition to a rescue inhaler. Please see your VA doctor and make sure you tell him or her how often you are using your albuterol and that you need to rely on OTC Primatene on occasion. With this information, they should be able to help.

So what happens when u can't afford to go to a doctor and when u have the condition that u need the med without it ur gonna die anyway so who is the government to do it and who do u think u r ? All u drs r ever interested in is MONEY not the people cause god knows if u don't have money or insurance u sure in the hell won't take care of a sick person. I wish all of u would go through what a real person goes through one day then maybe ull change ur mind . Get off ur high horse this med helped people with asthma that can't afford to see a dr all this is is the government s way of KILLING off poor people!!!!!!!

It seems to me as though this product helped more than harmed. I definitely suffer fromchronic bronchitis and last year I was prescribed an inhaler that really did help, however, ihave no insurance and went to the community clinic. It cost $125 just to be seen, plus $75 for the inhaler. I am still waiting to get into a local community healthcare clinic that has a sliding scale fee but until then i get to pay that price agaib tomorrow for the same Dr. That sawme last year to prescribethatsame $75 inhaler wheni could have gotten primatine cheaper and faster. I also do not believe you need a medical degree to understand symptoms and to draw your own conclusions regarding treating health issues. I have been treating mine and my family's ailments for years with herbal remedies after consulting books with bith conventional, herbal, dietary, and homeopathic remedies. I have successfully diagnosed ailments and gone to doctors who have corroborated my research and agreed on what i believed certain conditions to be. I have also been to doctorsforserious reproductiveissues that were blown off by certain doctors and nurse practitioners who just didnt care enough to do more research so ive been on both ends of the stick and a medical degree doesnt mean anything if you cant or wont properly or ethically treat someone. I may only be an LNA but i know quite a lot about pharmacology and also how to properly read labels. Instead of taking these products off the market why not lobby for moreEDUCATION to help train people to properly manage and trear symptoms without conventional medical interventions......ohwait I know why because then America would no longer be mass media sheep just following along to the slaughter. If you educate and give more resources people wouldn't be hospitalized and dying from OTC misuse.

My father who is 79 and has been diagnosed with Emphysema for 7 years, takes Primatine and Ventolin for his lungs. As a long term smoker of 50 plus years, it's not only non-shocking, but a pretty good bet that he would have this disease. I am shocked however to see him continue to smoke/ and use the inhalers to alleviate his wheezing which as you probably can/ could guess has progressed to him now needing 02 therapy. I am a non smoker and almost 50. I begged him from the time I can even remember being around to stop. I would cut his cigarettes so they couldn't lite, but in loads to explode them, and write on them ' coffin nails' death stix' or more. What is terrible and sad is that I love him, and begged him to stop, and he didn't. He even was diagnosed with Lung cancer 5 yrs ago but is in full remission. He's a guy who lived his life on his terms, but alas, here has come an inevitabilty of the use of drugs and o2. I know of a few people who passed due to this disease and think that it's ridiculous that primatine could be as much of an ozone killer as the belching mills from china or any other industrial nation. The do gooder's in this country have the right mindset of doing what's right, but NOT at the cost of things like this. I truly hate to see a great guy like my dad who was a good provider, in his situation and think that what we really should be doing is PUTTING tobacco companies out of business rather than Primatine. The truth of nicotine and enhancements to cigarettes are the killers of more than the ozone. I'd imagine that the pollutants from initial and second hand contact are far more dangerous than all the cfc that is in the canisters of primatine. Far More!

I have relied on Primatine for many years and have never had any adverse effects. I probably over use it as well. To take this very effective treatment away from me and others like me is criminal. I have tried countless times to find a treatment that works, only to stay with primatine because it works. I am counting the days until I run out and my life becomes unbearable. Thank you EPA and all you other do gooders.

Please know that my comments here are not in any way personally directed at you or any specific physician, because I do not believe that physiucians are evil or out to harm people or take advantage of them. What I do believe is that the medical industry as a whole is just that - an industry - anbd it has Big Government and Big Pharm backing it up because that is exactly how they make their money. I would venture to say, Doctor, that you pay more income taxes than many of the unfortuante souls on this board, so you are more valuable to Government than low-income asthmatics who can't afford a $50 office call. That is not your fault; it is the nature of the beast.

That said, I appreciate your assistance in offering me advice on clinics in my area, but this is just an example of what I am talking about about the naivete that "There are free clinics and things you can do." No, there are not. Don't you think people have already looked? If there was a solution, surely there would not be all these posts on your blog, complaining about the criminal act of sentencing millions of lower-income Americans to a potential death based on the fact that they cannot afford to step foot in a doctor's office or a clinic because they have the audacity to work beyond the point of qualifying for assistance but below the point of being able to afford a $50, $125, or more office call, on top of constant prescription costs. Surely you see that those prescriptions do not even work for everyone, even after people fork out the money to have someone write them out for them. I am not the only one on this blog who will suffer the loss or harm of a loved one while the ozone goes protected (allegedly). When medication is not affordable, and medical treatment is not available to the masses because of income, people have no choice but to self-medicate, and when that option is taken away, people have no choice but to suffer. It was kind of you to offer to send me to your friend in Bowling Green so my husband could get help, but that doesn't solve the problem for the millions of others who will possibly die or find themselves missing work, stuck in ERs, bankrupted, and having to choose between their kids' dinner and their ability to breathe. Pulling Primatene is a statement to the masses that the necessities of the common laypeople in this country are not as important as politics, income taxes, and environmental concerns, and that is a sad, sad statement indeed. It's nice to know the squirrels and trees will be able to breathe at the expense of human life because that $18 inhaler that we used to be able to buy when we needed it has now fallen victim to red tape and a scheme to force people to pay dearly for the right to breathe. I suppose it's a lesson we should have all learned at birth: It took a huge amount of money for us to be born in a hospital and have a doctor slap us to get us to take our first breath, and the medical industry is still trying to slap us with something before we can breath. And yes, it IS an industry. Frankly, it is a crime that the medicine was pulled without a replacement, becuase it directly endangers masses of people's lives, and anyone who supports it is a criminal party to standing by and watching people suffocate on the grounds of saving the environment, when we all know the only thing being saved is the hassle of having to deal with the uninsured and those who are not in higher tax brackets. Again I say, way to weed out the little guy, world. Maybe you should just start starving us too, or just shooting us on sight based on our 1040.

I'm sorry to repeat what everyone else has said, but I have also been extremely upset about this. I wrote my senator but only got a form email in response. It seems there is nothing more to be done - the pharmaceuticals and health care companies have won. Again. It wouldn't surprise if aspirin is eventually taken off the market too.

My father had severe asthma and after a trip overseas where I ended up in the hospital, I was put on a prescription inhaler. I suddenly found my condition was much, much worse; I had seen this same thing happen to my father (one reason I never used an inhaler). I forced myself off and used Primatene for years. When I got pregnant I was again forced to go on albuterol. I agreed for my child's sake but afterward went back to Primatene. We're talking years with no problems. Now it's back to the awful albuterol. One problem, I believe, is the way albuterol is metabolized by the body; some of it remains and that seems to aggravate the condition, not help it. Adrenaline is produced naturally by the body. What studies have been done? I've seen very little.

It doesn't matter the negative effects of how albuterol is metabolized by our bodies. What seems to truly matter is the effects of Primatene on the freaking ozone - and even more so, the effect of its availability on the bank accounts of insurance companies, doctors, and the government's income taxes. I hate to be so harsh, but any person who is honest enough to admit what is truly happening will clearly see that it is simply a matter of human life being placed on a sliding scale of value. Common people who need to buy their inhalers at Kroger or Walmart instead of forking out big bucks to see a doctor and then for prescriptions are less valuable to the government than higher-earning ones and the environmentalist PACs that place human health behind the importance of an alleged hole in an alleged ozone. Interestingly enough, cigarettes are OTC, and they SAY ON THE LABEL that they cause cancer, not to mention we all know that they pollute the almighty environment. Alcohol is OTC. For that matter, Big Macs are OTC. Why? Because all these things make money for the medical industry by making and keeping people sick, and the medical industry then, in turn, pays heavy income taxes. Money makes the world go round, and that $16 inhaler at Walmart wasn't earning enough of it for somebody. My husband has enough of a borrowed inhaler to last two more weeks. If there are to be regulations on things, it should be on the government sentencing people to an early death.

Dr. Mintz - I'm 43 years old, a professional engineer, and have had asthma since I was 14 years old. Its funny how you vigorously defend albuterol and so against Primatene Mist, but in one of your own posts you admit that there is NO data on how dangerous, or not, Primatene Mist is. And you somehow just know "it's as dangerous as albuterol". There is no data so you can't make that kind of claim. It's ridiculous. If Primatene Mist was so dangerous or associated with deaths it would have been pulled off the shelves years ago (The big name pharmaceutical companies would have made sure of that). It’s a cheap shot to get it banned because of the little bit of CFC it contains. FACT is I have used ALL of the different brands and treatments over the years (Alupent, Provental, Serevent, ProAir HFA,etc.. including you precious corticosteroid combos like Advair. Those treatments can be expensive, far less effective with much greater risks and side effects than the low cost OTC Primatene Mist which I have turned to when ALL those others failed. This whole issue is about control and money, period. I know my comments will not be posted but as you read this just know that there are educated professionals out here that understand what is really going on. We do write letters and have a voice. I will continue to get Primatene Mist through other sources, until those sources deplete, as I can afford too. I feel sorry for all the people who will suffer because of this and you as a doctor should put their health and well being above all else. You sir are part of the growing problem within the medical community of the big pharmaceuticals controlling the FDA and our doctors.

Dr. Mintz - I'm 43 years old, a professional engineer, and have had asthma since I was 14 years old. Its funny how you vigorously defend albuterol and so against Primatene Mist, but in one of your own posts you admit that there is NO data on how dangerous, or not, Primatene Mist is. And you somehow just know "it's as dangerous as albuterol". There is no data so you can't make that kind of claim. It's ridiculous. If Primatene Mist was so dangerous or associated with deaths it would have been pulled off the shelves years ago (The big name pharmaceutical companies would have made sure of that). It’s a cheap shot to get it banned because of the little bit of CFC it contains. FACT is I have used ALL of the different brands and treatments over the years (Alupent, Provental, Serevent, ProAir HFA,etc.. including you precious corticosteroid combos like Advair. Those treatments can be expensive, far less effective with much greater risks and side effects than the low cost OTC Primatene Mist which I have turned to when ALL those others failed. This whole issue is about control and money, period. I know my comments will not be posted but as you read this just know that there are educated professionals out here that understand what is really going on. We do write letters and have a voice. I will continue to get Primatene Mist through other sources, until those sources deplete, as I can afford too. I feel sorry for all the people who will suffer because of this and you as a doctor should put their health and well being above all else. You sir are part of the growing problem within the medical community of the big pharmaceuticals controlling the FDA and our doctors.

@anonymous 2/19,Let me be very clear on my position. I object to rescue medications of any type being over the counter, because I do not think it is safe for asthmatics to manage their own disease without the supervision of a physician. There is very clear data that over use of beta-agonists correlates with worsening asthma, hospitalizations and death; and over use of beta-agonists are much more likely if not supervised by a physician.I recognize that this position is not popular by many of the posters here because it requires a visit to the doctor, which is expensive if you don't have health insurance. Our health care system is terrible in that so many don't have access. However, this does not justify bad medicine. Furthermore, there are options for free care across the country. "If Primatene Mist was so dangerous or associated with deaths it would have been pulled off the shelves years ago." This is not entirely true. The burden of proof for "dangerous" is far greater for over- the-counter than prescription products. Tylenol is a perfect example. Tylenol is a very dangerous medicine if not used appropriately, and it is very clear that Tylenol has killed many people. The problem is that in order for Tylenol to be pulled from the market (which I am not necessarily advocating) it would have to be proven extremely dangerous even with normal use. Very few OTC's get pulled. Contrast this with something like Avandia, where there has not been one actual study proving it causes harm (and one study that proves it doesn't) and now there are so many restrictions, the FDA has essentially banned this medication.As far as albuterol vs. epinephrine, there is no study that compares both products head to head, so there is no clear evidence that one is more harmful than the other. It is clear that epinephrine has more side effects than albuterol, so in theory it is more dangerous. Again, if there is a clear reason for Primatene to be available for those that do not respond to albuterol, I have no problem with this being used, as long as it is under a doctor's supervision, i.e. a prescription. Lastly, though I try to be as environmentally friendly as I can, I have no idea what damage the CFC's in asthma medication would do to the ozone layer, and therefore am not a proponent of removing these medications for this reason. That said, I am in favor of Primatene being off the shelves because I think asthma self-management is dangerous. "This whole issue is about control and money, period."You are certainly entitled to your opinion. In my opinion, the issue is about public safety. Asthmatics who are using Primatene without the guidance of a physician are at risk for severe consequences including death. I don't want to see any more deaths from asthma.

You (and other physicians) claim you don't want to see any more deaths from asthma, and that's commendable, but if that's the case, perhaps you should leave your profession, because I assure you that the removal of Primatene--many people's only chance of breathing due to ease of access and affordability--you are going to see countless more asthma-related deaths than you have ever seen before. Just because a doctor writes a prescription on a piece of paper, that doesn't mean it's any safer than the things people use at their own discretion. While there is some validity to the argument that doctors know more about the reactions people may have to medication, those living without any ability to buy any medication know far more about the reactions people have to having no help whatsoever. All prescriptions really ensure is that doctors, insurance companies, pharmaceutical companies, and the government by trickle-down get their cut. If this is not true, prove it. Stop backing the pulling of medications, herbals, and other remedies that help just as well (in some cases better) and just as safely (in some cases more safely) as the chemical crap you are scribbling down on those prescription pads that you probably got free from a pharmaceutical company trying to get you to peddle their products.

@autiej"All prescriptions really ensure is that doctors, insurance companies, pharmaceutical companies, and the government by trickle-down get their cut." I won't disagree with this, but this is a system that I didn't design. I can tell you that if primary care physicians are getting their "cut", we got the raw end of the deal. I will not disagree with you that the health care system needs a lot of improvement. This is not the point of the post. I would support ALL medications being available to ALL people without any cost to the patient.

"Stop backing the pulling of medications, herbals, and other remedies." Other than Primatene, I have not backed the pulling of any medications. In addition, I am not even saying we should pull Primatene. My issue is that it should not be over the counter.

"herbals, and other remedies that help just as well (in some cases better) and just as safely (in some cases more safely) as the chemical crap you are scribbling down on those prescription pads."There is absolutely no data the herbal medications are better than prescription medicine and are safer. Patients spend billions of dollars on vitamins and herbal supplements of little proven benefit. There are a few supplements and herbals(calcium, vitamin D, possibly glucosamine, possibly saw palmetto) that are actually safe and effective but most are "crap." In regards to actual over the counter medications (Primatene, Ibuprofen, Prilosec), most were prescription before they were over the counter, so to suggest that what I prescribe is "chemical crap" and the Primatene you can get over the counter is any different is simply not true. Finally, and most seriously, in regards to deaths from asthma; perhaps I did not make my reasoning clear. If you are using Primatene once a week or less, then it is probably OK, and risk for death is probably pretty low. However, most patients who take Primatene take it more than this, and in fact, many use it several times a day. The problem with this approach is that it simply treats the symptoms of asthma and not the underlying cause of asthma, which is inflammation. According to the NIH and WHO guideline, patients taking rescue medications more than twice a weeks should be on an inhaled corticosteroid. Allowing Primatene to be sold over the counter substantially increases the risk of patients taking too much rescue medication without an anti-inflammatory. This in turn increases the risk for hospitalization and death.

I never said Primatene was different. What I said was that the difference is that doctors, and Big Pharm and Insurance profit from anything that is not over the counter. THAT is the only difference. Evidence? You've spent this blog arguing how dangerous Primatene is, yet now you say you'd be willing to prescribe it as long as it is not over the counter. That sickens me further. Again, it is a matter of who is profiting off the illnesses of others. And I will not argue with you about herbals, because any medical doctor will argue against their validity. I am not to blind to see why, since it - like Primatene - keeps many people from paying for prescriptions and doctor visits. In fact, most of those chemical medicines you prescribed are derived from herbals. I have seen with my own eyes and in my own body that they do, in fact, work - often better and safer than synthetics. You can argue all you want with statistics and studies, but I know they have worked for me and for people I care about, and that is the only statistic I need. I know that at 3 a.m., when we have no money to go to a doctor or to fork out for an E.R. bill, Primatene has kept my husband breathing. In any case, this is a pointless argument. The medical industry refuses to admit that it is, indeed, an industry - in it to make money by profiting off a guaranteed income source because all of our health is doomed to fail over time. It is ironic - or maybe not - that medications are pulled once it is realized that they are not bringing in a profit for that giant industry. I don't believe doctors are evil or greedy on a case-by-case basis, but if people can find remedies outside the insurance-doctors-big pharm circle, somebody loses big bucks, and that is simply not tolerated. We should all be entitled to benefit from human advancements in medical science, but unfortunately, that privilege is limited to those who can pay ridiculous prices for it. No family should ever have to decide between one of them breathing and the rest of them eating. And when over the counter aides that work are pulled so they can be regulated and profited from, many families have no other option than to make such a choice. READ the posts here. SEE that Primatene works for many people. ADMIT that it the medicines you prescribe (and profit from) offer just as many threats and side effects and sometimes less help. And then, for the sake of your oath to help people, DO something about it.

@autiejYou seem to imply that physicians, drug companies, and environmentalist all sat down together and said, "OK, how can we stick it to the poor and sick and make money while doing it.?"Though all three parties have not been perfect, I find this scenario that you imply in your post far fetched. Clearly, the environmentalist who went after the CFC's and the agencies that approved their withdrawal probably did not consider the unintended consequences for asthmatics. The biggest one of which is increased costs to patients for prescription medications. "No family should ever have to decide between one of them breathing and the rest of them eating." You are 100% right. We need real solutions to our health care delivery system now.However, this is not the point of my post. The point of my post is very simply that asthma is a serious disease and should not be self-managed by patients.

i had insurance until i married and they decided that since my husband made a few extra dollars i wasnt disabled anymore. i have no insurance and chronic astmah. i have used primeatene inhalers and got relief. the 9 dollar walmart inhalers DO NOT EXIST i called. theya re trying to kill off the sick ppl first. its plain as day or they would provide something affordable to ppl who cant AFFORD INSURANCE!!

Dr. Mintz- I commend you for offering this blog and reading and truly answering comments left here. I found your blog after feeling extremely lousy all day. I had used an abuterol inhaler many times over the course of the day with very mild results. I was feeling bad, wondering how I was going to make it through the night feeling like this, wheezing and coughing up mucus. Finally, out of desperation, I pulled out an ancient, expired Primatene inhaler I abandoned after being told it was terrible for those with high blood pressure and being prescribed the abuterol. One puff and seconds later complete relief that has lasted for hours now. Not a single cough after the puff with several hundred coughs in the preceding part of the day. I feel like a complete idiot for listening to the doctor and ignoring my own knowledge and instincts. I went from feeling horrible to wonderful in seconds. Thank god I did not dispose of this wonder drug. I am currently feeling delightful for the past several hours thanks completely to one single puff of Primatene. I note your compassion and care...you sound like a wonderful doctor. Unfortunately, in my personal experience, you are as rare as the golden ticket in Willy Wonka. I have had nothing but terrible experiences with doctors, optometrists and dentists in my 40+ years. Con artists as a group; I trust a 3-card monty dealer on the streets of New York more that most doctors I have come into contact with. From mistakenly drilling the wrong teeth, oh nevermind...just thanks for being one of the good ones...

I used primatene for years. I have prescriptions for advair and albuterol. Generally my asthma is under control. However if i have an asthma attack the albuterol is no where near as effective as primatene. The feeling of suffocating is a very unpleasant experience. Primatene needs to be brought back until our simply idiotic government can come up with a suitable replacement.

Clearly from some of the people commenting on this blog, some patients are less responsive to albuterol that epinephrine (Primatene). I am not aware of alot of comparative studies validating this, but variable responses is common with any medication. I have no problem bringing Primatene back to the market. I just don't want it being used without a doctor's supervision.

@ "I just don't want it being used without a doctor's supervision" = "We just don't want it being used without someone making money off the office call and prescription." The truth is, if the "danger" was really the reason for it being pulled, we couldn't buy cigarettes, alcohol, aspirin, caffeine pills, or freaking fast food over the counter. ALL of those are known to be dangerous and even fatal at some level when abused, yet they are still for sale because they are not able to be forced into prescription only. It is a money thing, plain and simple. On the Walmart shelf, Primatene doesn't make money for Big Med or Big Pharm. We may not all be wealthy, but we are not idiots...and we're not too stupid to see what's really going on.

@autiejI have tried to be respectful regarding all of your comments and concerns. I have provided you with information about getting free care for you and your family, and even personally reached out to a physician not too far from you that would see you for free. However, you continue to suggest that there is some conspiracy between Big Pharma, the government and doctors where they collectively decided make of some BS environmental reason so that we could deny therapy for patients in order for Big Pharma, doctors, and even the government to make a few extra bucks. This is simply ridiculous, and I can not continue to respond to this line of thinking. I will not argue the merits of the danger of CFC's from MDI's. I am not clear that the tiny benefit this might have provided to the environment was worth the potential harm and additional costs for patients who need these medications. However, I can tell you that primary care physicians are not making big bucks off of patients who now need to be seen to get a prescription of albuterol. If you have been paying attention to the national debate, there is a huge primary care shortage. We do not lack for patients. There are plenty of patients to fill appointment slots. No need to require visits for previous Primate users in order to pad our wallets.The issue here is not about money, but about access to affordable health care and the appropriate practice of medicine. It borders on criminal that our society can not ensure health care services for all of our citizens, especially when most other countries have figured out a way to do this. Nonetheless, just because patients do not have access and coverage for healthcare costs, this is not an excuse to practice bad medicine. Using Primatene without the close supervision of a physician is indeed bad medicine.

Thank you for your insightful opinion Doctor. I do agree that primatene is dangerous, i know its not great on the heart. My problem is, albuterol works only in neb treatment for me anymore. The old CFC albuterol inhalers were great, for the most part. But even those i built a high tolerance for, using 3-4 puffs to clear up tightness, but the HFA albuterol inhalers have actually made my attacks worse at times. They never seem to reach the lungs, and yeah they have a cheap one for 14 bucks, but it literally only lasts me a week, with use of it once a day. That is unacceptable! I also understand it is best to get prescriptions under the supervision of a doctor, well thats fine if you have health coverage. The drugs my docs want me on, are insanely expensive. Now i do see this as an angle for the drug companies to capitalize. They will have a brand new patent, like they did with albuterol HFA and mark up the OTC price astronomically because walgreens and walmart wont be allowed to make a generic version. Please doc, with all your health logic aside, is it not better for someone to have a fast acting relief inhaler, that can SAVE them, or to not have anything and be forced to live in fear hoping a damn cup of coffee will clear them up, if they are so lucky to even be near home or coffee. I can tell you, i will not be able to go camping this summer, or anything that is outside of a hospital drive. This makes me wish i could grab a million 1980's hairspray cans and find these damn lobbyists and spray 100 tons of CFC in their face's! Anyway, the reason they took it off the shelf is absurd and it WILL result in people dying. So much for the whole "If it only saves one life" mentality. My rant is done.

Thank you for your insightful opinion Doctor. I do agree that primatene is dangerous, i know its not great on the heart. My problem is, albuterol works only in neb treatment for me anymore. The old CFC albuterol inhalers were great, for the most part. But even those i built a high tolerance for, using 3-4 puffs to clear up tightness, but the HFA albuterol inhalers have actually made my attacks worse at times. They never seem to reach the lungs, and yeah they have a cheap one for 14 bucks, but it literally only lasts me a week, with use of it once a day. That is unacceptable! I also understand it is best to get prescriptions under the supervision of a doctor, well thats fine if you have health coverage. The drugs my docs want me on, are insanely expensive. Now i do see this as an angle for the drug companies to capitalize. They will have a brand new patent, like they did with albuterol HFA and mark up the OTC price astronomically because walgreens and walmart wont be allowed to make a generic version. Please doc, with all your health logic aside, is it not better for someone to have a fast acting relief inhaler, that can SAVE them, or to not have anything and be forced to live in fear hoping a damn cup of coffee will clear them up, if they are so lucky to even be near home or coffee. I can tell you, i will not be able to go camping this summer, or anything that is outside of a hospital drive. This makes me wish i could grab a million 1980's hairspray cans and find these damn lobbyists and spray 100 tons of CFC in their face's! Anyway, the reason they took it off the shelf is absurd and it WILL result in people dying. So much for the whole "If it only saves one life" mentality. My rant is done.

@MistoffbeyondreliefThank you for your comments. I don't know your entire medical history, but in general, there is reasearch that tolerance of albuterol is diminished when patients use inhaled steroids. This is probably also true of Primatene. Don't know if you have been taking an inhaled steroid in addition to your rescue albuterol. However, this is why I believe asthma must be managed under the supervision of a physician. I realize that drugs are very expensive and not everyone has prescription coverage. However, the drug companies do have a variety of programs to help patients pay for their medications. For patients who have insurance (not including Medicare) most medications can be aquired for less than $25 a month (which I know is still a lot for many people, but still within reason). For patients without insurance, most people who are poor but aren't poor enough for Medicaid can get there medications for free by signing up for programs sponsored by drug companies. The process is not that horrible, but it does take time on the doctor's part, which is why many doctors may not even suggest these options. However, these options are both available and underutilized.

@dougclInhaled corticosteroids remain one of the most significant advances in asthma therapy. No other agent comes close to their efficacy. In addition, at low to medium doses are safe. Prior to inhaled steroids, severe asthmatics needed oral steroids which causes horrific side effects. In general, inhaled steroids should not cause pain in joints. In fact, joint inflammation/pain/swelling is generally treated with anti-inflammatory medications, steroids being the most potent. The amount of inhaled steroids that get absorbed in the blood stream is not likely enough to significantly help or harm ones joints. However, every patient reacts differently to different medications. I would strongly recommend working with a physician that is an expert in asthma to help you manage you situation. In fact, your situation highlights the main point of my original post, that asthma is complicated. Asthma treatment requires working with a clinician who has expertise in asthma. It is not something like a headache or heartburn where a reasonable adult can safely and usually very effectively treat his or her own ailment. The problem I have with Primatene is not any theoretical risk it poses to the environment. The problem I have is that it allows patients to manage a very serious medical condition without physician supervision. While I understand that due to our broken health care system, requiring a doctor's prescription/visit makes this financial and logistically difficult if not impossible, I don't believe there is enough justification to allow patients to self-treat asthma.

As I read all of this it sickens me. I was diagnosed with asthma when I was 12 years old. I have been struggling with it for 26 years now. I have tried all the other inhalors and none of them worked. At least not as well as primatene. As far as it harming the ozone, BS!! There are a lot of things out there that are harming our inviroment far more than primatene. You keep saying, " have your asthma evaluated by a doctor" even though people keep saying they can't afford one. If doctors these days didn't think a couple of minutes of their time was worth our life savings things might be different. Doctors use to actually care about their patients. Not true of the doctors today. Seems all they really care about is the jingle in their pockets. I am not attacking you personally and it is not true just for doctors. Seems that's all anyone cares about these days and it's a DAMN SHAME. As far as the side effects. You can say that's what it is about all you want. Doesn't make it true. Just because you get a prescription from a doctor it doesn't make the side effects any less severe. If you watch tv on any given day it always seems that 2.5 minutes of a 3 minute commercial is listing side effects including death. There seems to be more lawyers trying to get you to sue manufacturers of medicines than there where episodes of the Andy Griffith show. The bottom line is that Doctors, Pharmasutical companies and the government alike just flat out don't like competition. They can't stand to see anyone getting a piece of their pie and that's exactly what low cost over the counter drugs are doing. Yes some people have access to free clinics but not all. Yes you might be able to get free samples from a doctor but you have to be able to afford to go see one first. You saying that we can always just go to the ER because they have to see you whether or not you have insurance is laughable. The last time I went to the ER they charged $100 on site before I could leave. That wasn't counting the other bills. Then when you can't pay the bill they take you to court, it goes on your credit and so forth. Then it ends up costing even more money you don't have. Primatene costed little money and we got the relief we needed without it costing us an arm and a leg. You keep saying we shouldn't self treat but when we can't afford to see a doctor every few weeks what other option do we have? Some of us know it is asthma because we were already diagnosed with it and it should be our right to choose whether we want to buy an affordable medicine or fork over a couple weeks pay to go get one from the doctor. As some of the others have said before, its a money game. I can guarantee that the use of primatene doesn't have near the impact on the ozone as factories, power plants, vehicles and so on. It's just like when we were back in school. The bigger the bully the more problems they cause. One can only hope that one day the big guys will start looking out for the little guys instead of picking on them.

The danger of Primatene is not it's side effects, though it does (for most patients) have more side effects than prescription albuterol. The danger of Primatene is that it is a rescue or emergency medicine. It should be used more than twice a week. Anything more than that without means that asthma is out of control and is dangerous. This is why asthma must be managed by a physician, and usually involves the use of controller medications, which are only available by prescription. So many people have responded to this post by stating that they can't afford to see a doctor or take prescription medication. This is tragic, and clearly shows that are entire health care system is broken. Every American should have access to affordable healthcare. Thus, the question is should we condone poor medically care (letting asthmatics take Primatene whenever they want and without the supervision of a physician) because people don't have health care coverage. I believe we shouldn't. There are ways to get free or low cost medical care in most areas and most drug companies will provide free medications for those in need. I understand that this may not be convenient, but the alternative which will lead to patient deaths is not acceptable to me.

"There are ways to get free or low cost medical care in most areas and most drug companies will provide free medications for those in need. I understand that this may not be convenient, but the alternative which will lead to patient deaths is not acceptable to me."

Until there are "ways to get free or low cost medical care" in ALL areas, it has nothing to do with convenience. "The alternative, which will lead to patient deaths" may not be "acceptable" to you, doctor, but what is not acceptable to the millions of people in this country who cannot have their health tended to because they cannot afford it is that their deaths will be the result of greed and misplaced priorities. This is not directed at you personally, but your argument that people should not be allowed to care for themselves because it is dangerous is weak from the standpoint that SOME care by themselves is better than NO care because they can't afford it. Have you read the posts here at all? If people cannot breathe, they cannot live, and many cannot breathe because they cannot pay. They could breathe with Primatene, whether it was the healthiest choice or not, because at least it was a choice. The alternative to THAT is what is not acceptable to me.

@autiejHere's where we completely agree:"what is not acceptable to the millions of people in this country who cannot have their health tended to because they cannot afford it"

Here's where we disagree. Care is available. In the US, the poorest have Medicaid. The gap exists between those not poor enough to have Medicaid, but do not have health insurance from an employer or other means. For those people (and 50 million is staggering), there are options. Between free clinics, pro bono care provided by some doctors, and programs from the drug companies; patients can get care. It may be extremely difficult, i.e. travelling long distances at inconvenient times, but it is not impossible. If it were truly impossible to get medical care without health insurance, I might agree with you.

"free clinics, pro bono care provided by some doctors, and programs from the drug companies"'

This is simply not true. You may believe it to be true or have been told to believe it to be true, but it is really just propaganda, a nice little distraction when someone wants to control people as we are being controlled and exploited when it comes to our own health. Free clinics are not free for most people. Pro bono care seldom happens in real life (though it sure looks good in the movies), and "programs from the drug companies"? If there are, they sure do a good job of hiding themselves from people who could use them. It is naive to think these programs either exist or are easily and widely accessible, because they simply are not, even if it is the robotic response programmed into doctors to say when someone complains. The vast majority of that 50 million cannot benefit from any of these programs, which is one reason why Primatene should not have been pulled. If these programs were so widespread and available, this blog would not go on and on and on with people complaining, would it? It has nothing to do with driving distances or inconvenient times, as I'm pretty sure someone would be willing to go at any time to save their life, especially to be able to breathe. It has to do with M-O-N-E-Y. Did you not see the post from the man who was forced to pay $100 before he could even leave the ER? Have you not read the posts here that have said that even with so-called free clinics that are seldom free, prescription medication, combined with office call costs, still force people to choose between eating or feeding their children and breathing? Primatene may not have been your choice for people's care, but ultimately, it is their health and should be their choice - not yours, not the government's, and certainly not the pharm companies who want to make a profit off of it. You admit that it is "extremely difficult," and when someone is struggling for their next breath, they don't have time for difficult. But it is like talking to a wall... a very big and powerful and greedy wall who refuses to hear what the people are screaming and justifies its existence by reciting the self-justifying lies that "oh, but we've provided another way," even when that way does not really exist. As I've said before, we may not have medical degrees because we work in different careers, and we may not have very much money or live in big houses or drive fancy cars, but we are not stupid, and we see what is going on. Primatene was pulled because someone was not making enough money, period. It wasn't pulled for the environment, or cars would be illegal by now. It wasn't pulled because Big Med really cares about its effects on our health, or cigs and alcohol would have been pulled a long time ago. It was pulled because it allowed people to choose their own "affordable alternative" - and the medical industry doesn't like those two words for sure.

@autiej,We are going to simply have to agree to disagree. Free clinics and medication programs do exist, though they may be difficult to find or get to. I have personally given you several options for you and your family, so I know these exist at least for you. I am not trying in any way to diminish the fact that this is still unacceptable. People should have easy access to affordable health care. In regards to your other theories about why Primatene was taken off the market being about "money," I will not argue simply because I don't have proof that this is not the case. However, you seem to imply that doctors, drug companies, environmentalists, and the government (or some combination) met and conspired to "stick it" to the poor in order to make profits. There is really no proof for this either. (Though I would be open to the idea if you had any evidence other than "now people need to go to the doctor to get a more expensive prescription").

That is proof enough, friend. I do not believe doctors, on the whole, are evil or are out to get anyone, as no one would spend thousands of dollars putting themselves through medical school and spend their days treating illnesses and listening to sick people unless they had some shred of compassion. What I do believe, however, is that Big Med, Big Pharm, and the government do, in fact, try to stick it to the poor people - the "surplus population," as good ol' Ebenezer would have put it - because they are easy targets. It is a bully-picks-on-nerds-because-he-knows-there-will-be-no-viable-resistance conundrum. It is easy to win a war against opponents who cannot fight back, and the impoverished or hardworking people who barely eke by have been the targets of taxes, fees, and governmental control for far more generations than this one. The fact that "now people need to go to the doctor to get a more expensive prescription" IS the proof of this. You only don't see it because you are not suffocating beneath the weight of that reality. As far as you offering assistance to me personally for my family, that is highly commendable, but that does nothing for the millions of others--including the ones on this board--and it is not a burden that is yours anyway. I think all people are looking for is someone to acknowledge that there is an evil going on, and that evil is that money HAS taken precedence over human compassion, and that we are no longer allowed to make decisions on medications that we want to use because our very bodies are being exploited for a profit. Deny it all you want, but the fact that Primatene is not on the shelves and cigarettes, fast food, and car emissions still are is all the proof I need. Marlboro will make their money, McDonald's will make theirs, Ford and Chevrolet will make theirs, and now the producers of albuterol and the doctors who have to give permission to buy it will make theirs because we have no alternative. Some need to keep people sick, and all need to make sure that the sick keep paying, whether than can afford to or not. So, yes, we will have to agree to disagree. But sometimes the only proof you need is a good look at what's going on around you.

I found this blog after being prescribed an Albuterol inhaler by my MD for a sinus infection with some chest congestion/wheezing and decided to do some searching on Dr. Internet for side effects/dangers/general information on inhalers since I've never used an inhaler before (scary things, inhalers - not sure now if I want to use it after all).Anyway, I do agree that "Big Pharma" is out to make a buck. Every single company on the planet is out to make a buck. Why else do companies exist, right? If people hadn't figured out that whole mass production thing we'd still be working off the land and trading chicken eggs for a scrap of burlap to make that new Sunday-Go-To-Meeting dress.We'd also still be dying from tetanus, tuberculosis and diphtheria at alarming rates. So medical research and Big Pharma have done a bit of good here and there.And before I go further, no I do not work for a pharma company. I also am one of the 50 million who does not have health insurance. I paid my $75 office visit today out of pocket and I will have to pay for the meds out of pocket. The Albuterol is going to cost me $45 for the generic, the prednisone is another $25 and the antibiotic $4.I missed work today, so that's another $100 or so.So who am I angry with? Dr. Mintz? Nah, he didn't shove that pollen up my nose.My MD? Well, $75 for less than 2 minutes of your time is a bit much, but there's that whole building you have to pay for - not to mention the light bill and water bill. And salaries for the front desk clerk, filing clerk, referrals clerk, appointments/phone clerk. And the person who has to hunt down my chart every single time I call for a prescription refill. And the nurse. And accountant. And let's not forget the malpractice premiums.Big Pharma? Nope. They're going to supply me with the medication I need to get better and not die of sepsis from an out of control sinus infection. The Government? Yeah, maybe a little. But then again, I honestly don't think we're guaranteed health coverage by the constitution. "Pursuit of happiness and a cheap HMO" doesn't ring any bells. The Insurance industry? NOW we're talking. The entire reason (I believe) health care has gotten out of control in this country is because of the insurance industry. Quite frankly I think the best thing for this country is to completely do away with private insurance. It's too expensive for the average consumer and doesn't pay the MDs as much as most people think.My MD's office offers an incentive for self pay patients - 25% discount for an office visit that is paid in full at the time of the visit. Why? Because that's all the insurance company will pay and it cuts down on man hours required to file with the insurance company. Saves the office money in the long run.In fact, I seem to recall a movement by some MD's who are starting to refuse insurance from their patients and go to a "fee for service" type of practice....which is resulting in lower office fees and better care for their patients.

At any rate, auntiej and Dr. Mintz I have enjoyed reading your discussion and think both of you bring up salient points, but I just couldn't help but throw "Big Insurance" into the bonfire.

And for the record, I would not dare use an OTC product that contains epinephrine without first getting approval from someone in the medical profession. And Dr. Internet doesn't count.....

There is no use arguing with that doc, he is like all docs of today, just put your life in my hands and if my medicine kills you (which thousands have died with side effects of prescription asthma medications), we'll say OH thats too bad but sure glad you didn't take the primatene (which I haven't read or heard of anyone dying from using so far). We want to control you just like the government, and all your money that the gov. doesn't get - we want. They are brain washed from the pharmaceutical companies who are making billions from these drugs and will do anything to keep them on the market and keep docs prescribing them. Even all the info you are given says to ask a pharmacist about it - AS THE DOCTORS don't really know about them. And they are still giving other drugs another 2 years before banning the propellent in primatene. I'm sure that propellent is really a big risk to us with all the other huge factory and car fumes around the world -yea sure. You can fool all the people some of the time and some of the people all the time but you can't fool all the people all the time and WE THE PEOPLE can see thru you docs and the pharmacutical companies and sky rocketing prices for meds and the control you want over everything over the counter. I seen your article on aspirin, etc., saying (No you didn't want to control it YET), that says EVERYTHING. I also think that either the pharmaceutical companies and/or the doctors bought out the company that makes primatene which should have came up with another propellent right away as there are other propellents being used in other meds on the market, so something is fishy going on there too. Watching this and big companies moving their industries out of the U.S., giving other countries bargain prices and us the shaft and you wonder why we don't BUY american anymore. Or have any respect for our doctors, etc.

Yes, snotnosedsurfer! Insurance companies are inherently evil! Hey, pay us a bunch of money every year just in case something happens. Oh but wait, when it does we will not cover that because it's a "pre-existing condition". Lab work? Oh no, we don't cover that either. I was actually told by a physician friend once that if he was a single man he wouldn't have insurance but rather would open a savings account just for paying medical bills should they arise. At the end of the year if he had not had to use it he would take a portion of the money and go on vacation. Second behind the insurance racket is the drug companies though. Guilty, guilty, guilty! I blame the doctors themselves the least of all for our healthcare issues in this country but they are not completely off the hook. As with anything, I think it depends on the individual. Some doctors really did go into their line of work because they desired to heal others. And some are in it for the money.All this being said, I am one of the many asthma sufferers that have found better results from primatene mist than albuterol inhalers and have not had any success from the "longterm asthma control" medicines such as advair. In fact, my asthma improved after using primatene. I used to have a nebulizer that I needed several times a year. However, after using primatene for a while my nebulizer has collected dust in my bathroom closet for about 5 years now.Sadly with the FDA ban I too am back to using albuterol in the form of a ventolin inhaler. Nowhere near as effective as primatene. Unfortunately I was a little late hearing about the imposed ban and was unable to stock up. Dr. Mintz states that all primatene studies are outdated so I wonder why no one bothered to do a new one to support the argument that it's a dangerous OTC drug. Seems a bit irresponsible and opportunistic if you ask me. People are complaining about the cost to the patient associated with this move and I can tell you it is pretty high. I do not have insurance or a regular doctor so off to the CVS minute clinic I went. $80 for the visit and $50 for the ventolin with only one refill prescribed. To get more I will have to go back and pay another $80 for the visit to get 2 more inhalers. What sense does that make? I have had asthma my whole life. Of course I'm gonna keep needing inhalers. I'm not magically going to stop needing them. Why can't I get more refills?Healthcare reform is this country's biggest need right now in my opinion. Of all the issues on the table in Washington this one is the most important I believe. Affordable healthcare for EVERYONE should be our goal. And that should be from the top to the bottom. I miss my primatene. I hope that there will one day be a reasonable substitute.

I was diagnosed with chronic bronchitis when I was 16, and often have asthmatic outbreaks. I have been prescribed every inhaler in the book and none have had any results. Albuterol has been the most prescribed to me. The last time I went to the docs I had a bit of a wheeze going on and the doctor set up a nebulizer with albuteral. I told him of the lack of outcome I get from it. He gave me a breath test, then the nebulizer. Another breath test. Another nebulizer. I left the doctors with a worse wheeze and a prescription for albuterol. None the less, my primatene mist supply just ran out, and I have no idea what I am going to do. Any suggestions?

@theonlyjohnsonMy suggestion is to find another doctor if the medication you usually got was albuterol. If you have chronic bronchitis since your teenage years, you likely have severe and complex respiratory disease. This should probably be managed by a pulmonologist. If you live anywhere close to a medical school, I would recommend seeing a pulmonologist that is full time faculty at that medical school.

If these safer medications were sold over the counter, than I'm all for other options. To be honest, I am not a "doctor" person. Of course, for some things, it is necessary. I mean, we really can't do our own surgery.

There are times when we should be allowed to be our own dr.s. We know our bodies and conditions and most of the time, we know what we need.

My point is, consumers should have access to many medications that are "prescription only". More over the counter options should be available.

I definitely understand and appreciate your perspective. However, I must disagree with your statement "There are times when we should be allowed to be our own dr.s. We know our bodies and conditions and most of the time, we know what we need."Asthma kills over 4000 Americans each year. In the US, there are over 200,000 hospitalizations and 2 million ER visits due to asthma. Asthma deaths, hospitalizations, ER visits and exacerbations are all correlated to use of rescue medication. The more rescue medication an asthmatic takes the more likely bad things are going to happen. According to the guidelines, asthmatics taking rescue medications (albuterol, Primatene) more than twice a week need to be on a maintaince/daily medication to prevent these bad events from happening. The best thing for this is inhaled corticosteroids. The problem is that patients will happily take Primatene or albuterol once a day or more not thinking there is anything wrong because they feel their symptoms are controlled. Though physicians need to do a better job tracking albuterol use in their patients, unrestricted use of Primatene is a huge concern for me because there is no way to track patients that are potentially in trouble. Of course, there are many stable asthmatics that get by on rare use of Primatene and are certainly inconvenienced by needing a prescription. However, I think in the bigger picture this inconvenience is worth the prevention of even one asthma death. Now, as many responders to this post have mentioned, prescription asthma medications are expensive. Their response would be that there is no need to prevent me from taking Primatene once a day because I can't afford the inhaled corticosteroid you say I should be on. This is completely understandable and prices for prescription medicines are too high for many patients. However, every drug company has a program that people who can't afford medications can get them.

"Asthma kills over 4000 Americans each year. In the US, there are over 200,000 hospitalizations and 2 million ER visits due to asthma. Asthma deaths, hospitalizations, ER visits and exacerbations are all correlated to use of rescue medication." Right, Doc. But keep an eye on those statistics of yours, because I guarantee that over the next few years, since there is no nothing available and affordable over the counter, those numbers are going to go up. In the past, my husband had to go to the ER for his asthma once. Since they pulled Primatene, and we simply cannot afford office calls and prescription meds, we've had to make countless trips there and will continue to have to do so. A $50 albuterol inhaler doesn't last him any longer than a $20 Primatene one did (less time, actually), not to mention the $100 office call, even at the supposed community clinic for economically suffering folks.

@autiejOur central disagreement is whether or not certain medications which may lead to overall bad outcomes should be made available over the counter, even with some risk, because access to affordable health care and medications is bad for many Americans. My opinion is that we should not allow this. We should try to fix the poor system that encourages patients to spend hard earned dollars on suboptimal medical care. Two wrongs do not make a right. If SCOTUS does not boot the ACA, you and your family should be able to qualify for affordable health insurance in one of the many exchanges that will be offered in 2014.

Look at all the people suffering from asthma that disagree with you Dr.Mintz. It is you who is misinformed. Stop spewing the propaganda of the drug companies who are against OTC's. Your objective is so transparent; quite frankly, you make me sick.

I feel horrible for all the people suffering with asthma. This is why I went into medicine. OTC bronchodilators are not the answer. A good doctor patient relationship with appropriate medication is the answer. There is no question that our health care system has failed many Americans. We need to work to fix this. However, two wrongs do not make a right.

Yes, "we need to fix this," and it is good that people recognize and "feel horrible," but UNTIL it is fixed, Primatene was the only choice many asthma sufferers had. My husband now owes the so-called "free clinic" $200 just for going in there to get asthma prescriptions, which cost $50 and put our family in a bind every time he has to have a prescription refilled. THAT is not okay for families who struggle, like many of the people on this board. Two wrongs may not make a right, but one of those so-called "wrongs" was keeping people alive while the government flails about, flip-flopping over the other "wrong" that people cannot afford. OTC bronchilators ARE a good answer when the only other answer is "Sorry. No money for the ER, prescriptions, doctor visits equals no breathing." For many people here and out in the world, Primatene was the only answer, even if it is an answer you and the medical community doesn't see as ideal.

@autiej$50 is certainly a lot to pay for medications for some people, but I don't believe it is so exorbitant to justify over the counter meds.If your income is so low, you should be able to qualify for Medicaid. If you income is not low enough to qualify for Medicaid, and you don't have other insurance, you should be able to get almost any medication free through the drug companies. If you fall into one of those two categories, then you shouldn't really have to pay anything for prescription albuterol.

A lot of shoulds there, doctor, but that's what the people here are talking about. Those "shoulds" sound good on paper and when recited to hopeless people who need help, but if you read the posts here, you would know that those "shoulds" are just propaganda, like the poster up there said. And one man's definition of exorbitant is not another's. My family eats on less than $50 most weeks, so yes, it is exorbitant enough to justify us wanting the $16 back on the shelves. We could afford Primatene AND groceries. Imagine that. And we're definitely not alone, as the chain of comments on this blog attests to.

Dr. Mintz, thanks for standing by your statement. Im a 3rd med student, and my preceptor was just telling me how dangerous he feels primatene mist and afrin is.

For the rest of you anonymous posters; just STFU. "Well, I've used cocaine lots of times and I feel great!" Thats essentially what you're saying. Just cause you've used it fine, you think its just dandy.

You think docs want to see patients like yourself for a few $? No, Im pretty sure they'd rather you dumb ungrateful shits just stay home and rot.

Don't even try to argue with me, cause you can't even spell right. You'll just embarrass yourself some more.

Stop blaming everybody else for your own life. I get it: You're broke, you're poor, you can't afford to see a doctor, etc. So you blame the doctor?

Do you blame the supermarket cuz you can't afford food? Or the gast station?

Nobody owes you jack shit. Every single word out of you is pure speculative garbage. Im sorry, did you do a survey of 1000+ people to get your medical data? Tell us about all the books you've read, the patients you've seen. You think a cancer patient is an expert on cancer? You think just cause you have asthma, then the world owes you something?

Dr. Mintz is a polite guy, so let me say it: @auntieJ, you need to wake the f up.

First of all, it's autiej, which is short for my name. There's no N in it, just in case you're still worried about those who can't spell.

Second of all, if you took the time to read the posts here, you would see that no one thinks anyone owes them anything. Most of the people using Primatene were doing so because they had no affordable alternative, and that is what the complaints are about--a go-to remedy being pulled when it was the only remedy some had access to.

And third of all, I know Dr. Mintz is a nice guy. He has personally extended help to me for my husband's condition (by the way, you'd know, too, if you took time to read the posts that my husband has asthma, not me). The fact that he allows people to state their disagreements here and offers rational answers and rebuttals speaks to his demeanor and his character.

The comments here do get heated, because it's a heated issue. No, cancer patients do not know what's safe for them to take as much as doctors do, but if there were something they could take over the counter without having to fork out thousands of dollars (which many of them don't have, and that's more of a fact than a complaint), it would be an alternative for those living on the cusp. And for the record, how many cigarettes are sold every day? Those are pretty toxic to the environment and the people inhaling them by choice or force, yet they're still on the shelves. THAT is the problem most people are having with this. It is all about money, and insulting the people on this board isn't going to do anything.

I appreciate the fact that Dr. Mintz has allowed this forum to go on, even in the midst of heated discussions. He has said the health care system in this country needs fixing, and I agree with him on that.

So, you can continue to insult the people on the board, or you can look at the real issue, which is that some people do not believe Primatene should have been pulled when there is no affordable over-the-counter medicine to replace it for those who cannot afford to go to the doctor every three months for new prescriptions - prescriptions that cost three times as much sometimes as the Primatene did. It may not have been the perfect, ideal solution, but for many, it was the only solution accessible to them, and it was better than no solution at all.

If the goal is the protect the consumer from themselves, I say that isn't a good enough reason. In fact, if someone is too lazy or too stupid to read and follow directions, then let them kill themselves. The world doesn't need more stupid people.

Ahh yes, someone who makes their money pushing Big Pharma drugs is telling us "little people" how to live.

I have news for you doctor, albutrol is available in many many places without a scrip, trust me on this.. and Primatene Is not going away any time soon. It will be back and you will continue to try to brainwash the public into thinking its horrifying.

Contrary to what you are telling people here, many used Primatene because it was ALL THAT WORKED. Ive done my time with doctors and drugs, none of them gave me any help whatsoever.

I just came across here from another board. Doctors without asthma who think it's a great idea that primatene inhalers were banned make me very angry. Albuterol does not work for me, I don't know why. I'm a pilot, not an M.D. After primatene was gone I tried the asthma pills but they didn't work well, and were useless in an emergency scenario. There's a new alternative, same ingredient as primatene, with a tiny little nebulizer, asthmanefrin OTC. It has given me my life back. I've used it 30 days now and already lost 13 of the 30 pounds I gained due to inactivity from fear of an attack. Going skiing next week. I still hope for a more pocket-friendly version but primatene being banned was a nightmare for millions. A nightmare. like waking up paralyzed or blind. Shame on you doctor, shame.

Asthmanefrin OTC would be great IF it worked. As soon as it was introduced to our store shelves, we rushed out to buy it, as my husband was tired of practically suffocating daily since the Primatene ban, and we were excited that he might actually be able to take a walk again or do anything active. However, just a few days after buying it, the thing stopped working and does not allow him to inhale the medicine. We had bought it out of state so we couldn't return it to the store, so I wrote to the Asthmanefrin company to let them know I need a replacement, and all I got from them was a bunch of form letters and excuses and a promise to send a "new plastic clasp," which wasn't even the problem (and by the way, they never sent the plastic clasp). The ONLY solution here is to bring Primatene back. But of course, that little $20 life-saver costs far too many pharm companies and docs far too much money...

Thanks Doctor for espousing the "party line" I guess you're just going to ignore the 40+ YEARS that this OTC inhaler has been used safely and effectively, huh? It wasn't banned by the stupid FDA because of side effects, it was banned because the CFC propellant harms the ozone layer. What BS. Lets kill off (death panels, anyone?) the millions that found relief from Primatene Mist so we can save the effing planet. Just stay true to your BigPharma masters so you can keep your medical license. Doctor?....Ha!

Anonymous,You have obviously not read the many comments on this post or my responses. I agree that the environmental rationale for pulling CFC's is probably a non-issue. However, I feel strongly that epinephrine should not be available over the counter. FDA approved this years ago under different rules. It would likely never be approved today for a prescription medication, let alone for OTC use. The makers of Primatene decided that rather than go through the process of developing an HFA epinephrine product (which they realized was an unwise investment since as I stated the FDA would like re-consider their grandfathered status), the company decided to lobby Congress to get an excemption from the rule that all other albuterol manufacturers had to comply with. They did not succeed.

It would be nice if I could just go to a doctor and get a new prescription for my albuterol every year. But I have no insurance. So I guess I should starve my children, then. Or else just suffer through my asthma attacks. Because I can't really spend $300 to see a doctor once a year just to get one prescription. But hey, at least no one has to worry that I'm running through a prescription faster than a year. That will be a comfort to my family when I'm dead from not being able to afford a doctor visit to get a prescription for a medicine that a mature adult might be able to properly monitor on their own.

He's been getting the same prescription for decades now. The other prescriptions come and go, but ALBUTEROL IS ALWAYS THERE.

ALWAYS.

The UK is selling albuterol OTC, now, and that's in a nation where EVERYONE has health care. This was a decision that the NHS made to cut down on the load of patients hogging up doctors offices for the same old medication they're always going to get, anyway.

It's been that way for a while now and guess what?

IT'S NOT BEING ABUSED!

ASTHMATICS AREN'T DYING IN THE STREETS!

AND THEY'RE STILL GOING TO THE DOCTOR WHEN THEY'RE SUPPOSED TO!

Of course, it helps that they have a health care system that cares more about people than how much money the sick have, and aren't this conglomeration of blood-sucking pigs known as doctors, hospitals, insurance scam artists and pharmacological giants that we have in America.

And you are a freaking nutbag for thinking that taking Tylenol or Aleve off the market would be a good idea.

It wouldn't be.

I tell you what, cupcake: When more people die from taking Tylenol for normal reasons than from the incompetence, negligence and greed of doctors, then you can take Tylenol off the shelf.

I shouldn't have to pay an nutbag like you to get something to relieve a headache or fever.

Alright, and I want to respond to another one of your comments above. Apparently you think bronchodilators should not be available over the counter because people do not know they should also be using corticosteroids for treatment ... so the answer is educatin -- not the artificial requirement that they have to see "doctors". What is a doctor? It's just another person who has read some books about the body and then gotten rubber stamped after putting themselves through a 10 year meat grinder. Non-doctors aren't somehow subhuman or unable to comprehend what they themselves need to do. Look, people can get educated if they need to do more than just use a bronchodilator, and it doesn't have to come from a doctor's office. I am sorry to say but your views show a tremendous conformity and desire to cling to a standardized system for no apparent reason. It looks to me like you are primarily concerned with keeping your own notion of self importance and authority maintained, and what you need is a psychologist more than us mild, seasonal asthma sufferers need a doctor.

What is very bothersome is, that the folks against PMist didn't offer discounted or free office visits, nor did they offer an option at the same cost of PMist. So who benefits from taking PMist off the market?

Physicians and Pharmaceutical companies.

I personally would like to see the data produced that would indicate how dangerous PMist is. How many deaths were related to it. What was other factors of the study.

My husband has suffered greatly. The inhalers are $50-60 a month, they make him nauseous all the time. For 25 years he used one PMist every 3-5 months (depending on the weather), @ 17.99. He used 200 pumps in less then a month with the prescription he received by the doctor. Every 3 months he has to go back for a "check up". What a hack of crap. Basically per year we have to pay 1000.00 that we didn't have to pay for.

BTW, I lost my job and our insurance. He is self employed and has to pay extra deductible of 3500.00 to be treated,(because of asthma)Add in family deductible of 2500.00, we can't afford it.We only have major medical.

Please explain how it is fair? Ask yourself how good will you feel if you had to go to the state to get insurance? It is humiliating, the employees are so very rude. They treat you like you are a piece of crap that failed. Only to find out, we don't qualify. I was so hurt and embarrassed by the treatment.

One is not allowed more then one inhaler, and in Iowa, it gets cold. His clogged last winter when we had all roads frozen over, and we had to watch him breathe, as he dropped to his knees. Emergency couldn't get to us, 15 minutes away to a bigger town, but the roads were frozen, many vehicles in ditches.

How would you feel if your children watched you struggle to breathe, in fear of their dad dying? It was very traumatic.

So, please explain how this is a good thing? It has caused nothing but heartache and financial burden to us. Please email me with any suggestions. Brandi Mastainblmast@live.com

If it was, then the physicians would of offered a free visit, and an alternative inhaler at the same cost as PMist.

How many people died using PMist? What were other factors? Would like the link to the data (PROOF), that says it is dangerous.

Go and apply for state aid? Embarrassing, and very humbling to find out one doesn't qualify.

Last winter my husbands inhaler clogged, and he dropped to his knees struggling to breathe. See they don't let you have more then one inhaler. It was the day when most of the state was frozen over, and travel impossible.

Can you imagine how traumatic it was for our children to see that?

He used on PMist every 3-5 months, @17.99. Now it cost $50-60 a month plus an office call every 3 months @ $90-120.00

We only have major medical insurance, and it is very costly. He now uses 200 puffs a month. It's like it backfired on him. Makes him really dependable. He gets so sick to his stomach with the inhaler, and his breath is just horrible.

It's time the victims of this horrible situation stand up and be heard, call those who represent you, or send me your story @ blmast@live.com I intend to hound our representatives, until something is done.

Should last a year huh? And you try taking those horrible steroids, enjoy the leg cramps and irritated throat. Have fun losing your voice and having a constant sore throat. I used to have a Primatene for over 3 months with no issues, now these shit RX things barely last 2 weeks. And cost almost 100 bucks. You try being able to maintain your asthma when the doctors don't listen that they don't help! The side effects from the steroids are terrible, and even if you can suffer through them you still are not gonna get more than a month from the albuterol inhaler. Give me a break.

This original post was rather naive. In order to get a "prescription" for Albuterol a Dr's visit is required which almost always includes several mandatory "tests", "Xrays" etc. The cost of a visit then goes into the unaffordable range when these tests are included. An OTC inhaler is a much needed product when desperate measures are required. Dr's don't really care if you're suffocating only if you can afford their fees and tests.

About Dr. Mintz

Dr. Matthew MintzI am board certified in internal medicine and have been practicing for over a decade. I am also an Associate Professor of Medicine at an academic medical center on the East Coast. My time is split between teaching medical students and residents, and caring for my patients.